Short-Term Natural History of the Standard Approaches for Gastrostomy Tube Placement in the Pediatric Patient

Abstract

Gastrostomy placement is a common procedure in the pediatric population. Standard approaches of tube placement include open, laparoscopic, and percutaneous endoscopic methods. Placement of the gastrostomy in relation to the fundus and the anterior abdominal wall is crucial to ensure adequate comfort and functionality. Misplacement may require repositioning of the gastrostomy, the rate of which has not been well documented. We, therefore, have reviewed a multi-institutional experience with gastrostomy tube placement to determine the short-term natural history of placement, based on approach, and to establish a cohort to determine the long-term natural history. We conducted a retrospective review of all pediatric patients who underwent percutaneous endoscopic, laparoscopic, or open gastrostomy placement at two institutions from 2000 to 2008. There were a total of 1534 patients who underwent gastrostomy tube placement during this time period. The most common procedure was fundoplication with gastrostomy (N = 832), followed by gastrostomy alone (N = 420), and then percutaneous endoscopic gastrostomy (PEG) (N = 285). There were 4 (0.3%) gastrostomy tubes that required repositioning to a new site due to encroachment upon the rib margin. Two were open and 2 were PEG (P > 0.99). Twenty of 39 patients who had an open fundoplication following gastrostomy had the gastrostomy taken down during the procedure, compared to 5 of 31 patients (P = 0.03), who underwent laparoscopic fundoplication following gastrostomy. These data demonstrate that the need for gastrostomy tube repositioning is rare in the short term, regardless of approach, although a takedown of the gastrostomy is more likely when an open fundoplication is performed.